One of the key concerns with lifelong antiretroviral treatment (ART) is the potential development of drug resistance. Managing ARV treatment in children is particularly challenging, as they may not be tolerant of medications with a bad taste, or of the form that the medication takes. Drug resistance testing enables clinicians to make informed decisions about what type of ARVs would be most suitable for a particular patient.
During the last years, more and more new-born babies and older children develop, for various reasons, resistance to the antiretroviral drugs provided for free by the Government. HOPE Cape Town has set itself the goal, to provide as many resistance tests as possible to these little patients to improve their lives and to give them a chance to live a healthy life.
To keep these children in treatment successfully, a resistance test will be done. HOPE Cape Town has supported the government health system since 2011 with resistance testing for the little patients. Since 2015, the process of ordering a resistance test from the state sector has become significantly easier. Thus, it is more widely available through the National Health Laboratory System (NHLS). There are however strict criteria for getting a resistance test through the NHLS, such as:
- Patient must have 2 Viral loads >1000
- Patient must be failing on a Protease Inhibitor – and have been on a PI for >1year
- Patient must have relatively good adherence – i. e. have been attending clinic regularly for past 6 months and have had any adherence issues addressed
There are often children that need resistance testing that do not meet those criteria – for these children HOPE Cape Town is still providing resistance tests.
HOPE Cape Town in South Africa currently provides funding for HIV genotypic resistance testing. Financial sponsorship enables us to provide resistance testing for HIV positive children who are failing either their first or second line of treatment, as well as for HIV positive new born babies who were exposed to HIV through their mother. Although resistance testing is expensive, it provides invaluable information which allows doctors to make informed decisions about how best to proceed with treatment.